Lost in the trees as obesity persists

TIME Magazine recently ran a cover story entitled: “The Weight Loss Trap: Why Your Diet Isn’t Working.” The particular focus related to the welling interest in personalized approaches to everything. While American culture has long been “me” oriented in comparison to most of the world and much of history, we have apparently taken it to a whole new level now. I hear routinely at conferences that millennials don’t want generic health messages; they want information customized just for them. Children of a cyberspatial age, they are used to it; they expect it.

Weight loss and health goals are, naturally, caught up in this prevailing cultural flow. To some extent, that can be a good thing, and this is where TIME’s article has its merit. There are, indeed, variations in genes, metabolic responses and the microbiome that predict the best variation on the theme of eating well for any one of us seeking to be lean and healthy.

But the article made almost no mention of history, and none at all of culture. Obesity is a New Age problem; it existed 30 and 100 years ago, but was much less prevalent than it is today. To account for a change in X, we cannot invoke all of the interesting properties of Y; we must invoke a change in Y. A change in an effect is almost without exception attributable to a change in a cause.

Obesity is the effect. And while it is true that the many measures of individual variation are among the potential causes of obesity in an individual case, those have not changed in the past 30 to 100 years. Our genes are the same; our metabolic pathways are the same. Our epigenetic settings and microbiomes can and do change over short enough time scales to matter, but changes in the epigenome and microbiome are, like obesity, effects rather than causes.

Diet and lifestyle affect our chromosomes, epigenetic settings and our microbiota just as they affect our weight. If we are blaming the fattening of the world on epigenetic and microbiomic alterations, it merely repositions the very question with which we started: what caused those?

The history of the past century is one of staggering social, cultural and environmental change — and all that change has been obesigenic. We have even been told, more than once, that our food supply is willfully engineered to maximize eating for the sake of profit. How can an exploration of why diets “fail” ignore such considerations? America willfully propagates obesity for profit, then spends taxpayer money to explore the mysteries of the obesity epidemic.

Imagine studying respiratory problems in Beijing, China, by only focusing on the variation among individuals. You could note that some people are more vulnerable to asthma than others, some more apt to cough or wheeze on any given day. You could then devote yourself to a hunt for the variations in genes, or epigenomes, or microbiomes, or telomeres, or metabolomes of the more and less vulnerable Beijingians. And, of course, everywhere you looked for such variation, you would find some.

But you would obviously be overlooking something utterly fundamental to your understanding. Beijing is prone to such horrendous air pollution that there are days the government issues warnings effectively telling people they can breathe or go outside, but probably not both. How completely absurd it would be, what an abject case of missing the forest for the trees, to study asthma and respiratory ailments in Beijing, assess variation among individuals, and overlook the appalling things that have happened to the air all are breathing.

Of course there is individual variation in vulnerability to weight gain, or diabetes. But there are whole cultures that are prone to obesity, or not; cultural transitions that change the vulnerability of entire populations; and entire expanses of history that have made such concerns common or rare.

Some of us will do better than others on more or less dietary fat, higher or lower total intake of carbohydrate, a bit more or less daily protein. But soda, processed meat, chemical additives, artificial sweeteners, monstrous portions, trans fat, highfructose corn syrup and the dubious modern company they keep aren’t good for anyone. Just about everyone does better with lentils than lollipops; just about everyone is better off eating real fish than Swedish Fish; just about everyone is better off with walnuts than doughnuts.

More than 70 percent of American adults, and well over 2 billion people worldwide are overweight or obese. Those bell curves suggest system failure. Those bell curves toll an alarm for us all.

In other words, our culture is succeeding at making us fat for profit while we study the reasons diets fail. This will persist as long as we look right past the obvious forest to get lost among the trees.

And while it is true that the many measures of individual variation are among the potential causes of obesity in an individual case, those have not changed in the past 30 to 100 years.